Originally printed in The Journal of Human Lactation, Volume 19, Number 1: Page 21, February 2003. Shared with author George Hill's permission.

Lee(1) and Caplan(2) have observed that male infants who are circumcised have a more difficult time initiating breastfeeding.Surprisingly, this problem had not been previously reported in the Journal of Human Lactation. Difficulty in feeding after circumcision has been documented in medical literature since 1982. Marshall and colleagues studied 59 bottle-fed mother-infant pairs and reported adverse changes in feeding behavior postcircumcision.(3) More recently, Howard et al studied 44 bottle-fed and breastfed full-term infants who were undergoing circumcision. They reported,

Infants feed less frequently and are less available for interaction after circumcision. Subdued, less interactive behavior has been documented frequently. . . . Because most hospital discharges occurred 7 to 10 hours after circumcision, the data are inadequate to assess the duration of the effects on feeding. Neonatal circumcisions are often performed on the day of discharge with many neonates leaving the hospital 3 to 6 hours postoperatively. Thus the observed deterioration in ability to breastfeed may potentially contribute to breastfeeding failure. Furthermore, some neonates in this study required formula supplementation because of maternal frustration with attempts at breastfeeding, or because the neonate was judged unable to breastfeed postoperatively. This finding is disconcerting because early formula supplementation is associated with decreased breast-feeding duration.(4)

Medical authorities strongly recommend anesthesia for circumcision; however, a 1998 survey showed that 45% of doctors do not use anesthesia.(5) Circumcision is a painful, stressful, exhausting, debilitating, and traumatic experience for many infants. Emde et alfound that infants have prolonged periods of non-REM sleep after circumcision consistent with a theory of conservation-withdrawal,(6) so they are less capable of interaction with the mother.Infant circumcision is a nontherapeutic procedure without documented benefit for the infant.(7) Therefore, no harm can come to the infant from foregoing or postponing a circumcision. The Work Group on Breastfeeding of the American Academy of Pediatrics (AAP) formally recommends that such stressful procedures be avoided.(8) The AAP “recognizes breastfeeding as primary in achieving optimal infant and child health, growth, and development.”(8) Therefore, successful initiation of breastfeeding should be given absolute priority over neonatal circumcision.Prospective parents should be warned in advance of circumcision’s interference with breastfeeding. While current informed medical opinion does not support the practice, some parents, however, still have their baby circumcised. In this case, circumcision should be avoided at least until breastfeeding is well established. Such a recommendation should be a part of all printed materials regarding breastfeeding that is provided to expectant mothers in advance of delivery and should be volunteered by lactation consultants in every prepartum counseling session.References

The Case Against CircumcisionThe radical practice of routinely circumcising babies did not begin until the Cold War era. This institutionalization of what amounted to compulsory circumcision was part of the same movement that pathologized and medicalized birth and actively discouraged breastfeeding.Fleiss P. 1997. The case against circumcision. Mothering Magazine Winter 1997:36-45.Breastfeeding Must Be Given Priority Over CircumcisionProspective parents should be warned in advance of circumcision’s interference with breastfeeding. While current informed medical opinion does not support the practice, some parents, however, still have their baby circumcised. In this case, the circumcision should be avoided at least until breastfeeding is well established. Such a recommendation should be a part of all printed material regarding breastfeeding that is provided to expectant mothers in advance of delivery and should be volunteered by lactation consultants in every pre-partum counseling session.Hill G. Breastfeeding must be given priority over circumcision. J Hum Lact 2003;19(1):21.

Acetaminophen Analgesia in Neonatal Circumcision: The Effect on PainPreoperatively, all neonates fed well. Neonate feeding behavior after circumcision deteriorated in neonates in both groups. Of those breastfed, 2 of 11 (18%) in the acetaminophen group and 3 of 8 (37%) in the placebo group either were judged to have breast-fed poorly or required formula feedings after circumcision. Of neonates who were formula-fed, 4 of 12 (33%) in the acetaminophen group and 2 of 13 (15%) in the placebo group fed poorly after circumcision. Acetaminophen did not significantly influence feeding changes for either breast-fed or formula-fed neonates.Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4):641-646.

Circumcision II: Effects Upon Mother-Infant InteractionThe effects of circumcision upon mother-infant interaction were examined in an observational study of 59 mother-infant pairs during hospital feedings using a specifically designed mother-infant interaction observation system that examined 43 discreet behaviours relating to feeding, gaze, facial expression, vocalizations and touch. The experimental group was circumcised after the second feeding and the control group after the fourth feeding... Immediately following circumcision there were differences in the feeding patterns between the two groups. The experimental group exhibited fewer intervals of uninterrupted feeding than did the control group.Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-374.